The 3 Types of Advance Directives

The 3 types of advance directives are a living will, a medical power of attorney, and a Do Not Resuscitate (DNR) order. These legal documents communicate your healthcare preferences when you cannot speak for yourself, ensuring your wishes are respected during medical emergencies or end-of-life situations.

Creating advance directives is one of the most important steps in end-of-life planning. Without these documents, family members may face difficult decisions during already stressful times, and medical professionals may provide care that goes against your personal values or wishes.

Why Advance Directives Matter

Advance directives give you control over your medical care when you are unable to communicate your wishes. They protect both you and your loved ones by providing clear instructions about your preferences for life-sustaining treatment, pain management, and other critical medical decisions.

According to the National Institute on Aging, fewer than 40% of American adults have completed advance directives, despite their importance. This gap leaves millions of families unprepared for medical crises that require immediate decisions about care.

Source: National Institute on Aging

When someone becomes incapacitated without advance directives, family members often struggle with uncertainty about what their loved one would have wanted. This can lead to family conflicts, prolonged legal proceedings, and medical decisions that may not align with the person’s values or beliefs.

Type 1: Living Will

A living will is a written document that specifies your preferences for medical treatment when you are terminally ill, permanently unconscious, or in the end stages of a fatal illness. It addresses life-sustaining treatments such as mechanical ventilation, artificial nutrition and hydration, dialysis, and resuscitation efforts.

Living wills typically cover several key areas:

• Life support preferences: Whether you want mechanical ventilation, feeding tubes, or other life-sustaining equipment
• Pain management: Your wishes regarding pain medication, even if it might shorten your life
• Specific treatments: Preferences about dialysis, blood transfusions, antibiotics, and other medical interventions
• Organ donation: Your wishes regarding organ and tissue donation

A living will only takes effect when you are unable to communicate your wishes and your medical condition meets specific criteria outlined in the document. It does not affect medical decisions when you are conscious and able to speak for yourself.

The document must be signed in the presence of witnesses or notarized according to your state’s requirements. Most states require two adult witnesses who are not related to you and will not inherit from your estate.

Type 2: Medical Power of Attorney (Healthcare Proxy)

A medical power of attorney, also called a healthcare proxy or healthcare power of attorney, designates a trusted person to make medical decisions on your behalf when you cannot do so yourself. This person becomes your healthcare agent or proxy.

Unlike a living will, which provides specific instructions for certain situations, a medical power of attorney gives your chosen agent the authority to make a wide range of healthcare decisions based on your known values and preferences.

Your healthcare agent’s responsibilities may include:

• Consenting to or refusing medical treatments
• Choosing healthcare providers and facilities
• Making decisions about surgery, medication, and diagnostic tests
• Accessing your medical records
• Making decisions about comfort care and pain management

When choosing a healthcare agent, select someone who understands your values, can communicate effectively with medical professionals, and will advocate for your wishes even under pressure. Many people choose a spouse, adult child, or close friend.

You should also name an alternate agent in case your primary choice is unavailable. Make sure both people understand your wishes and are willing to serve in this role.

Type 3: Do Not Resuscitate (DNR) Order

A Do Not Resuscitate (DNR) order is a medical directive that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if your heart stops beating or if you stop breathing. Unlike living wills and medical powers of attorney, a DNR order is typically written by a physician based on your expressed wishes.

DNR orders are most commonly used by people with terminal illnesses, advanced age, or serious medical conditions where CPR is unlikely to be successful or would cause unnecessary suffering. The order applies only to CPR and does not prevent other medical treatments unless specifically stated.

There are different types of DNR orders:

• Hospital DNR: Valid only within the hospital setting
• Out-of-hospital DNR: Valid in all settings, including your home, nursing facilities, and during transport
• POLST/MOLST: Physician Orders for Life-Sustaining Treatment that include DNR instructions along with other preferences

If you have a DNR order, you should carry a copy with you or wear a medical alert bracelet indicating your DNR status. Emergency medical personnel are trained to look for these documents and will honor them when properly executed.

Family members should know about your DNR order and understand what it means. The order can be revoked at any time if you change your mind about your preferences.

How These Documents Work Together

The three types of advance directives complement each other to provide comprehensive coverage for different medical situations. A living will provides specific instructions for end-of-life care, while a medical power of attorney covers broader healthcare decisions throughout your life.

Many people benefit from having both a living will and a medical power of attorney. The living will serves as guidance for your healthcare agent, while the power of attorney ensures someone can make decisions in situations not covered by your living will.

A DNR order addresses the specific question of resuscitation, which may not be covered in detail in a living will. Having all three documents ensures your wishes are clear and legally protected across different scenarios.

Legal Requirements and Validity

Advance directive laws vary by state, but most states recognize all three types of documents. The documents must be properly executed according to your state’s requirements to be legally valid.

Common requirements include:

• Being at least 18 years old and of sound mind
• Signing the documents voluntarily without coercion
• Having the documents witnessed or notarized as required by state law
• Using forms that comply with your state’s specific language requirements

Some states have specific forms for advance directives, while others accept any document that meets the legal requirements. Many states provide free advance directive forms through their health departments or attorney general’s offices.

If you move to a different state, check whether your existing advance directives remain valid or need to be updated to comply with your new state’s laws.

Updating and Storing Your Documents

Advance directives should be reviewed and updated regularly, especially after major life events such as marriage, divorce, the birth of children, or changes in health status. You should also review them if your personal values or wishes about medical care change over time.

Store copies of your advance directives in multiple locations:

• With your primary care physician
• At hospitals where you receive care
• With your healthcare agent and family members
• In your home in an easily accessible location
• With your attorney if you used legal services

Many healthcare systems now include advance directives in electronic medical records, making them readily available to medical staff during emergencies.

Creating advance directives is part of comprehensive end-of-life planning that should also include other important documents. When planning for end-of-life situations, families should also understand what to do when someone dies and prepare for the first 24 hours after a death to reduce stress during difficult times.

Frequently Asked Questions

Can I change my advance directives after I create them?

Yes, you can change or revoke your advance directives at any time while you are mentally competent. Simply create new documents that state they supersede any previous versions, and make sure all relevant parties receive copies of the updated documents.

Do advance directives expire?

Most advance directives do not have expiration dates and remain valid until you revoke or replace them. However, some healthcare facilities may request updated documents if yours are very old, so it’s good practice to review them every few years.

What happens if I don’t have advance directives?

Without advance directives, medical decisions will be made by your closest family members or through court-appointed guardianship. This can lead to family disagreements and may result in care that doesn’t align with your wishes. Having a step-by-step checklist when someone dies can help families navigate these situations.

Are advance directives the same in every state?

While all states recognize advance directives, the specific requirements and forms vary. Some states have mandatory forms, while others accept any document that meets legal requirements. Check your state’s specific laws or use a service that ensures compliance with local regulations.

Can my healthcare agent override my living will?

Generally, your healthcare agent should follow the instructions in your living will. However, if circumstances arise that weren’t anticipated in your living will, your agent may need to make decisions based on your known values and preferences. This is why it’s important to discuss your wishes thoroughly with your chosen agent.

This information is for educational purposes only and does not constitute legal, medical, or financial advice. Always consult qualified professionals for guidance specific to your situation.